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Fee Schedule Updates

HealthChoice and the Department of Corrections provide fee schedule updates on Jan. 1 each year that reflect added, changed and deleted codes; however, the comprehensive annual fee schedule update occurs on April 1 of each year. This allows time for the Centers for Medicare & Medicaid Services to finalize and post its fee schedules.

The following dates have been set for all future fee schedule updates for services provided by HealthChoice and DOC Network Providers:

As a reminder, associations periodically change, add, correct or delete procedure codes throughout the year. When these modifications occur, HealthChoice and DOC review them as soon as possible and make any necessary changes. Additionally, the Office of Management and Enterprise Services Employees Group Insurance Division makes fee schedule updates on an ad hoc basis when necessary.

Inpatient and outpatient tier designations are updated on Oct. 1 of each year, based on the most current CMS fiscal year inpatient prospective payment system (IPPS) impact file for Network Providers. HealthChoice and DOC recognize counties designated by the U.S. Census Bureau as a part of a metropolitan core-based statistical area (CBSA) as urban.

Following each quarterly update of the HealthChoice and DOC Select fee schedule, outpatient rates for the procedures covered under the program will become fully phased in during the next quarterly update.

Fee schedule updates are reported in each issue of the Network News which is distributed quarterly to all Network Providers. Updates are also posted to the provider websites. We encourage you and your staff to reference the website of your provider network for the most recent fee schedule updates and other important information.

If you have questions, please contact network management by calling 405-717-8790 or toll-free 844-804-2642. Inquiries by email should be sent to [email protected].